NO THERAPY - USE, ABUSE, EFFICACY, AND MORBIDITY - THE EUROPEAN VERSUS THE THIRD-WORLD EXPERIENCE

Objective: Historical controls documented a marked reduction in compli cations from acute otitis media (AOM) and chronic suppurative otitis m edia (CSOM) with the introduction of antibiotic therapy in the period 1930 to 1950s amongst other changes that occurred in North American an d Western European society. Today, the natural history of spontaneous remission in AOM in over 80% of children within 24 hours of presentati on questions the raison d'etre for the routine prescription of antibio tics for what may essentially be a self-limiting condition. Metaanalys es of numerous antibiotic versus placebo trials in the treatment of AO M have demonstrated little difference in clinical outcome, as have tre atment stratagems where antibiotics have been initially withheld. More judicious use of antibiotic therapy in AOM appears to have been assoc iated with a decline in antimicrobial resistance in countries such as the:Netherlands and Iceland. It is difficult to know, however, whether the direct savings from decreased antibiotic use will ultimately lead to an actual decrease in the other direct and indirect costs associat ed with AOM. Unfortunately, children in the third world have not exper ienced a corresponding decline in ear disease. Significant loss of dis ability-adjusted life years (DALYs) continues to occur from otitis med ia. Withholding antibiotic therapy in the treatment of AOM would more than likely impose greater morbidity and mortality on an already disad vantaged population. Nevertheless, the experience of the Thai Rural Ea r Nose and Throat Foundation has been seminal in documenting and affec ting change in both the morbidity and mortality patterns of AOM and CS OM during Thailand's transition toward developed nation status. This a rticle analyzes these issues and provides a review of the literature a vailable.